Long Term Disability Claims – How to Start a Claim
Long-Term Disability (“LTD”) benefits are paid to employees who become disabled and unable to work due to an illness or an injury. While group insurance policies differ from company to company, in most cases the test for eligibility is a variation of the following formula:
- You are experiencing an illness or have suffered an injury from an accident; and
- As a result you are unable to perform the important duties of your own occupation.
The process for applying for LTD benefits normally involves completing a series of forms which are supplied by either your employer or the LTD insurance company.
The employee completes a form usually called a Claimant’s Statement which asks questions about your disability and how it impacts your ability to work. The Claimant’s Statement will also ask for a list of your doctors and information about medications and other treatments.
Your doctor will also be required to complete a form which is usually called the Attending Physician’s Statement. This form asks your doctor to answer questions about your diagnosis, treatment, severity of your condition and your ability to work. It is very important that when your doctor completes the form they do so as thoroughly as possible or your claim may be denied on the basis of insufficient information. I also recommend that your doctor attach important medical records to the form that will help confirm your total disability.
Your employer will also be required to submit a form called the Employer’s Statement or Policy Holder’s Statement. This form asks for details regarding your employment, including your salary and information about your work duties.
Once the forms have been completed and submitted, you will be contacted by a representative of the insurance company for the purpose of a telephone interview. They will ask you questions about your current symptoms and activity level, your job duties and details about your current treatment. They may also ask you to provide them with additional medical records such as your doctor’s clinical notes from your medical appointments.
Note that if you are already receiving short-term disability (“STD”) benefits then you may not be required to complete any new forms in order to transition to LTD benefits – you should check with the insurance company or assessment company that is managing your STD claim to ask whether a separate application for LTD benefits is required.
Long-Term Disability Benefits – When Should I Apply?
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All long-term disability policies will require you to first satisfy a waiting period (also called a qualifying period). This is the length of time that you must remain disabled before monthly LTD benefits will commence being paid. The length of the waiting period varies from company to company and can run anywhere from 3 to 12 months. With many companies the waiting period will match the length of the short-term disability period so that LTD begins as soon as the STD period finishes.
It is very important to submit your LTD application soon after you become disabled and certainly well before the end of the waiting period. Every policy will have deadlines for filing your claim and providing medical evidence in support of your disability. If you miss these deadlines, the insurance company may use that as an excuse to reject your claim.
Long Term Disability Claims – What if My Claim is Denied?
LTD claims can be denied for several reasons. The insurance company might allege that there is insufficient medical evidence to prove that you are disabled. They might argue that there is no “objective medical evidence”, meaning there is not an x-ray or MRI that confirms your symptoms. They may also claim that your symptoms do not prevent you from performing your job tasks or that you have not been getting appropriate treatment. For additional information on why claims are denied, see my blog.
A denial by the insurance company is not necessarily final and you will have the option to submit an appeal. Sometimes individuals will appeal by typing up arguments about why the insurance company has made the wrong decision. It is very rare for this type of appeal to be successful and often the insurance company will use your own words against you. For example, they may that argue that your ability to put together arguments in an appeal letter proves that you have the capacity to work.
Appeals have a very low probability of success in my experience. However, the appeals that I have seen be successful involve submitting new important medical information that might persuade the insurance company to reverse their decision. For example, new test results or a recent specialist report that confirms your total disability. Another example is a support letter from your doctor or treatment provider.
Often your doctor will not know what information should be included in a support letter. This will vary from person to person, but at a minimum the doctor should provide an explanation why in their opinion you are not able to perform the critical parts of your occupation. You can assist your doctor by making sure they understand the two or three most important tasks of your job. Your doctor can then explain why your symptoms prevent you from carrying out those critical duties. The support letter should also include information about your current and upcoming medical treatment.
Long Term Disability Claims – When Should I Call a Disability Lawyer?
You may call me at any time during the LTD claim. If you have any questions or challenges with applying for benefits I can assist you with navigating through that process. Certainly if your long-term disability claim is denied for any reason or your benefits terminated prematurely then I can advise you on your options, including assisting with your appeal or proceeding to start a lawsuit against the insurance company.
As always, there is no charge to speak with me about your case.
Call me for a free confidential consultation at 416-630-8880. Alternatively, please feel free to email me at info@disabledlaw.ca
Mark Yazdani
Long-Term Disability Lawyer
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